Provider Demographics
NPI:1407920861
Name:MARENICK, AMY W (MED, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:W
Last Name:MARENICK
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 GRISTMILL DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9801
Mailing Address - Country:US
Mailing Address - Phone:803-366-8727
Mailing Address - Fax:803-328-5443
Practice Address - Street 1:2400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-8968
Practice Address - Country:US
Practice Address - Phone:803-327-6103
Practice Address - Fax:803-328-5443
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1962101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC570629234006OtherBCBS